Basic Information
| Provider Information | |||||||||
| NPI: | 1528070067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADHVARYU | ||||||||
| FirstName: | DHAVAL | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4869 | ||||||||
| Address2: | DEPARTMENT 237 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772104869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777441141 | ||||||||
| FaxNumber: | 8475374866 | ||||||||
| Practice Location | |||||||||
| Address1: | 3600 FLORIDA BLVD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708063842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2253812660 | ||||||||
| FaxNumber: | 2253812638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 03/08/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD15173R | LA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1161314 | 05 | LA | MEDICAID |